Not Getting Your Period Is Not Normal

They’re annoying (because hiii monthly bleeding from down there), yet amazing all at the same time. I never appreciated my period until I didn’t get it regularly for over three years. And I was told by doctor after doctor to do a progesterone challenge or go on birth control. Really, I was just nuts about running and needed to gain a little weight and boom. Period. No drugs required.

Nowadays, when I’m regularly getting cycle I’m like…actually, authentically excited because it tells me things are working right in my body. And if it doesn’t come, because there has been a month here and there when it hasn’t, I take a step back and look at what has changed in my life. Am I stressed? How is my sleep? Am I eating enough? (that’s actually now never really the problem) Have I increased how much I’m running without being mindful of that?

I can’t even count the amount of times I was told “don’t worry about it” by multiple physicians and NPs throughout my late teens and early twenties when it came to not getting a menstrual cycle. I had blood work done, DEXA scans, and probably other tests, but not once did a health care provider ask about my exercise or eating habits.

My BMI was lower than my natural set point. Note on BMI –> women menstruate with a whole range of BMIs, what’s most important is that your body is at weight that is healthy for YOU. My senior year of high school and into my sophomore year of college I was on a spring break diet or simply trying always lose a few pounds (that sounds so exhausting now). Then I started to learn about the body and how it works so I ate more, but even though I was eating more responsibly, I still stayed around the same weight, still on the lower end of a “healthy BMI,” not once was I asked about exercise or what I ate by any physician.

Then, when I graduated from my dietetic internship in 2012 and took things into own hands and really started educating myself, I was absolutely baffled when I went to an endocrinologist specializing in women’s health and her solution was to prescribe birth control. I was also once told verbatim when I asked about exercise and its relation to amenorrhea, “There is no medical indication for stopping exercise. It is also not dangerous or unhealthy to skip periods.” WHAT?!

I don’t want to sound like I know more than doctors or other health providers because I most certainly have so much to learn and there are incredible providers out there. But I do think, as a health care profession, we are far undereducated about how lifestyle relates to reproductive health, and way too quick to prescribe a medication rather than getting back to basics with some lifestyle modification. I was at a dinner hosted by Monte Nido with a bunch of RDs who work in eating disorders and we got on this topic, and the passion surrounding this was palpable. I loved it because passion fuels change.

I could go on and on because I get so fired up about this topic. But instead, here are five things I didn’t know, but think you should know about your period and lack thereof.

You don’t have be a marathon runner to have exercise-induced amenorrhea. If energy and nutritional intake are not sufficient enough to support energy expenditure, the body begins shutting down organ systems that are not absolutely essential for survival – including the reproductive system. If your body isn’t getting enough energy + nutrients to support your own needs, then it’s certainly not going to think it’s in a healthy state to grow a baby.

But even if you do eat healthily and adequately, amenorrhea is still a common occurrence since exercise causes the release of cortisol – a natural and normal response to exercise. But these are the same hormones the body releases during the “fight of flight” response to any stressful situation (from you forgetting your wallet to you running from a burning building). Everyone’s body has a different threshold of when stress starts interfering with your hypogonadal pituitary axis to keep your menstrual cycle flowing regularly.

Sure, not having your period is convenient, but it has long term health consequences. So when I was continually assured that not having my cycle “was no big deal,” I began to wonder…how is a process that reproduces otherhumans no big deal when it goes absent? For me as a patient, as an RD, as an NP…this is a big freaking deal. When your period goes missing, there’s an altered production of reproductive hormones and women often are estrogen-deficient (there are other reasons as well).

Estrogen is like the queen of female hormones and when there’s not enough of it, bone health deteriorates leading to osteoporosis (leading to lots of injuries) in addition to infertility, breakdown of the vagina and breast tissue and there is even research to show prolonged exercise-induced amenorrhea may increase the risk of heart attacks later down the road. I don’t say that to scare you, but instead to perk our heads up and be like ok…this is not normal and not okay.

Just because you’re at a “healthy BMI” doesn’t mean you’re at a healthy weight for YOU. Typically, women need about 17% body fat to have their first period and about 22-23% to maintain a healthy menstrual cycle. That is what research shows. That is not the end all be all. But I hope it puts perspective on how having little body fat is usually not healthy.

In light of all the above though, every woman is different. There are women who run marathons and have very low body fat, yet healthily menstruate. There are also women who have an exercise threshold that is much, much lower. That’s okay. You are YOU. Looking at a woman’s BMI and shrugging off an irregular or absent period because she has a “healthy BMI” is ignorant and shoves the body and healthcare into an algorithm when every single patient is different.

The body’s hypothalamic pituitary gonadal (HPG) axis is super sensitive to changes in the environment. This rhythmic pulse of hormones happens on a regular schedule that is precisely timed. That means lack of sleep or insufficient energy intake or emotional stress or other environmental factors can effect this cascade of hormone release that causes a woman to menstruate. Which is why it’s so important to focus on appropriate sleep, stress management and self-care. Nobody ever mentioned those things to me or asked me about them for years.

FATS FATS FATS ARE SO IMPORTANT. We need fats in our diet to synthesize hormones. And eating enough calories AND nutrients is just as important. Now, any and all foods are part of a healthy diet. Any and all foods are part of a healthy diet. Any and all foods are part of a healthy diet.

But we would become nutrient deficient if we ate McDonald’s all day. So we need a balance of nutrients AND calories in order for our body to not be under nutritional stress. With intuitive eating, your body will tell you what it needs when, we don’t have to track or overthink things. We need foods that nourish our body and foods that nourish our souls too. Because stressing about eating healthy and avoiding all processed foods, well that’s a big point of stress and that’s not good either.

Not having a period isn’t normal. And we can’t just ignore it’s absence. But instead of just taking a pill to slap a band aid on the problem, we have to take step back, look at the overall picture, and get down to the root of the problem.

Seeing clients get a period for the first time in a long time or the first time EVER is my favorite thing, even better when they get pregnant naturally after being told they needed infertility treatment.

Our lady health is so so important.

Want more on this? Here are more posts I’ve written on this very topic <3

Comments

Oh man…this is so good. I’ve said it before and I’ll say it again: I just love you! Thank you for doing what you do! This is such an important message and, as someone who has spent most of the last 10 years NOT having periods, something that I am still working on…especially the weight gain component which can be a hard and slow aspect of recovery. These kinds of reminders are so so helpful. 🙂

I LOVE THIS. So freshman year of high school until the end of sophomore year, I wasn’t getting my period. I did not want to go on birth control, but I also didn’t want to gain back all the weight that I had lost from dieting (which now seems so silly!!) the worst part was that I never got “skinny.” So, I didn’t think that my eating habits were a problem. It wasn’t until I started following you that I realized how important my period is and how little I was eating (for MY body) /how stressed out I was/how little sleep I was getting. I started eating more, gained back a lot of the weight (which I’m still learning to accept,) became much more lenient with my workouts (my body only really only likes 4 days of Crossfit a week, which completely goes against my goal of 6 times a week,) sleeping more and stressing less etc. I had to learn that just because I wasn’t skinny, didn’t mean that my body was in a good place. Now, senior year of high school, I’m learning to accept my new body and understand that healthy looks different for everyone. My body is healthy and happy in the middle of the BMI scale (and at this point, I’m not weighting myself bc I lift weights and am gaining muscle + my weight messes with my mind, but focusing on how I feel, my relationship with food and if I’m getting my period.) So THANK YOU for everything ❤️

I have been on birth control (the pill) for the last ten years. In the last two years, I have either not gotten a period on my off pill week, or have had a semi normal period. Over 2 years, the semi normal periods have come about maybe 3-4 times. My gynocologist says this is normal if you’ve been on BC for a long period of time. Is the only way to tell if I am normal is to get off the pill? I’m not sure what to make of what they say and what my body should be doing, since the BC is “regulating” my hormones.

I was told by an OB/GYN in August that I didn’t need to have my period to be healthy – this was given as a rational for putting me on a birth control to stop my periods in order to deal with dysmenorrhea. It can be incredibly frustrating to hear these sorts of things from seemingly highly qualified health care professionals and it can be extremely exhausting to have to continually advocate for better answers.

This is a fantastic post! Thank you for writing. I had an irregular/missing period for a few years and like you, was not getting an answer besides to go on birth control, which I did not want. I went to a new gynecologist (who is also a runner) and explained my lifestyle and what she said next truly changed my life. She told me that, even though I wasn’t underweight, some women just need a little extra fat to menstruate. She encouraged me to increase the amount of dietary fat in my diet and see what happens. So, I did. I ate tons of avocados, peanut butter, cheese, and chocolate and then… I started my period. And I’ve had my period every single month since then three years ago while still maintaining a high level of running. I tell this story to all my girlfriends who, like me, are training hard because it’s so important!

Thank you so much for this. I have been without a period for 1 1/2 years. It took me a while to get my butt in gear once I realized how unhealthy this is for my body but I’m proud to say that I’m now fully on board with getting healthier. I’m eating more and have already gained 8 pounds. It was very hard for me to accept because I still at a “normal” BMI when I stopped getting my period. But I was exercising a lot and restricting food. Even though I haven’t gotten my period back yet I’m already feeling so much better! My hair is healthier, I’m less constipated, I’m sleeping better, and I just feel better. Thank you for educating women about what being truly healthy is all about!

Thanks so much for this post, Robyn! Too many of us have experienced amenorrhea and not addressed the root issue. I would love to hear more about when the mentality behind exercise becomes unhealthy. You provide such great insight so thanks again!!

While I agree you should pay attention to your body, I also believe you should do your research on other things that may be ailing your body that are not fully under your control. I asked for an ultrasound to see if I had PCOS (though I’m lean and healthy), and it turns out I did. Due to that condition, I may never get my hormones on board the way many people do with healthy lifestyle. If I didn’t know this, I would have driven myself crazy trying different lifestyle options with no changes in the frequency of my periods. I struggle when people don’t acknowledge these things, making women like myself feel less than for not functioning how women should.

I completely AGREE with you that you have to rule out medical abnormalities – which I why talk about not getting period because you’re just not getting your period is not normal, which is totally separate from not getting your period…because you have xyz.

But I would encourage you to seek out a professional who knows about healing PCOS and restoring a natural cycle despite the PCOS…I get this isn’t achievable with all women, but I have had a great deal of success helping women restore a regular cycle who have previously been diagnosed with PCOS.

Thank you so, so, SO much for what you do, Robyn. I felt like such an alien around my friends when I didn’t have my period. I have suffered with atypical anorexia, clinical anorexia and anorexia nervosa. Pretty much as soon as I began to restrict my intake my period stopped; yet, even after a year of intense restriction, overexercising and weight loss, my OBGYN said “well, we can’t really tell you to gain weight and you’re at a low-healthy BMI (my natural BMI is 25 and I was at 19!!), so we’ll just put you on the pill.” Lost more weight, no period still, no issue with my doctor. Three years later when I began rapidly gaining weight in recovery my doctor said “This is just to get your period back?” She didn’t understand. People need to be educated. I was so scared. So thank you!! 🙂

Oh my, I know what you mean about getting excited and grateful when you start bleeding each month because same! It really is one of those cases where you don’t know what you’ve got until it’s gone! Talk about taking for granted as well! I never ever hate on my period any more. I know how precious it is.

I have a question though…do you think people who have lost their periods because of (in my case) anorexia have a higher chance of losing it again even after it’s restored? I am a healthy weight and fat % but my periods have gotten irregular again in the last six-nine months (i.e. much much longer cycles). I lost it 7 years ago due to my eating disorder but had it restored 5-6 years ago and had zero problems until now. The only thing that has changed is that I have regularly been running for 18 months but not more than 20 miles a week so not insane. Is it possible my body is more sensitive because of the harm done to it before?

THANK YOU, THANK YOU. Although I’ve been lacking my period for five years due to an eating disorder, it’s only in the last two that I’ve really started to focus on recovering that part of myself, especially now that I’m in a much better (and happier!) mental state. I’ll admit: the thought of getting my period again is a little scary. I hated it growing up since mine were so heavy. Even after I was weight restored years ago, I didn’t really want my period, you know? But after racking up the injuries lately and reading advice about the other effects of amenorrhea like yours, I’m starting to realize just how much women are supposed to have their periods. This article was another kick in the rear-end for me. 🙂 I also love all the comments to prove I’m not alone!

The title of this post alone made me cry. I have been trying for over a year to get my period back after losing it from an exercise addition and restrictive diet. I had no idea what was going on as I had recently stopped taking the contraceptive pill and thought the period absence was from that. However after stumbling across your blog last year I had a huge revelation. I read everything you had written about amenorrhea and hormone health, and was just so so happy to be understanding what was going on. My eating was still lacking a lot of fats and carbs, sleeping was just not happening and I was stressed to the max. I have been slowly getting there and am happy to say that I no longer put my body through a grueling exercise regime and am eating so much more food. While my period hasn’t returned, I know that it is baby steps as the sleep and stress thing are still going on. Like you, I don’t want medicine to bring back my period, I want it to happen naturally and am confident that it will return the more I focus on healing my body and balancing my hormones. Thank you, thank you, thank you for bringing all this information to light for me, I can’t explain how much it has helped.

I love this! You are actually the first person to bring amenorrhea to my attention as a problem. I wasn’t get my period for years. Not because of too much exercise, but the combination of a high-stress lifestyle + not enough food. And once I learned to take a freaking nap and eat more – not just when I’m hungry but when I know I need to – it came back. And I’m the same way, every month is like a celebration of my beautiful body and femininity. And obviously the above formula worked for ME, it won’t work for everyone, and part of the journey is finding what YOUR body needs. xo thanks as always Robyn

Thank you for always being so honest in your posts! You bring things back to reality and it is so much appreciated.

Sidenote: reading your blog has inspired me to finally pursue what I really want to do in life, which go back to school for nursing. Right now I am super stressed taking only anatomy (albeit I and II) while working full time as a preschool teacher. It’s a little scary, but I’m pushing through!

I love this post! I’m a 26 year old woman and a nurse and I just stopped taking birth control for the first time in 10 years! My OBGYN prescribed it to me for menstrual cramps and no one ever suggested I trial off of it. I tried to stop it one other time and felt pressured to go back onto it because my hair began thinning and I didn’t feel pretty. I’m a strong, educated, clever woman and I felt enslaved to birth control because I didn’t think I could find a boyfriend without it! This time I’m determined to listen to my body and let my hormones balance themselves out.

As always, I love your thoughts. I agree that primary care physicians can not be concerned about periods. Thankfully, my doctor saw that I was 10lbs down from my last visit and encouraged me to eat some more healthy fats/food in general and see what happened. But if she hadn’t had my past visit information, she might not have mentioned it, especially since I was in the normal BMI range. Also, I think they are misconceptions about what EDs look like. The stereotype is super skinny means ED. Anyways, those are my thoughts/agreements.

Robyn, I have a really important question that I cannot seem to answer despite my efforts in research and talking with doctors. I have been suffering from an ED for years, and I am definitely underweight, and trying to gain weight. I have had ammenorhea for years, and of course, the “solution” was birth control, which I am on. I have two questions: (1) is there any benefit to being on birth control while I am trying to gain weight – many people suggest that being on the pill will supply estrogen to my system that is completely lacking estrogen in order to prevent any bone issues like osteoporosis while I am in the process of gaining weight – is that true? should I stay on birth control for my bones? (2) what are you thoughts on birth control in general, are there health reasons to not be on it? bad for the heart, etc.? I typically think going natural is best, but I also don’t want to have bone problems, so if being on birth control helps prevent bone issues while I gain weight, then fine, but I can’t seem to find hard evidence of that. And if being on birth control introduces further negative effects on health, then I don’t want to be on it. Anyway, I know you are busy, but if you could answer, that would be awesome!!! Thank you so much for this amazing post and forcing us to look at ourselves instead of putting fake bandaids on real issues. You are a rockstar. Thank you.

Thank you for this! Several years ago I was a running nut while also on Weight Watchers. This is something that worked in some ways but I don’t believe that the WW program (at least back then) was geared towards a runner’s needs nutritionally. I believe I was not fueling my body in a way that it could properly function and I did stop getting my period for about 3 or 4 months. When I saw the doctor they told me that it probably wasn’t the running because although I was exercising a lot I was still a bit overweight. To them they figured if I wasn’t emaciated then it must not be from exercise. I was left without answers and just sort of waited for things to return to normal. Cut to a few months later when I actually came down with SHINGLES! Again, I believe that this was due to the stress that I was putting on my body with all the exercise. However, because the shingles kept me from running, my body was able to return to normal and my period came. I have always found it amazing that my doctor didn’t put all of that together and instead I did years later! Thank you for addressing this topic so that other women don’t go through the same concern and confusion.

Loved this post because I relate to it so much. I too lost my period for very long periods of time (upwards of 8 months sometimes!) and was told the exact same thing you were – try birth control, take progesterone pills, this is normal, etc. etc. And it drove me insane because I KNEW it was not normal by any means. I went to an endocrinologist as well, which showed no distinct issues. So for a while I was in the dark about everything. My period started being consistent when I moved to NYC in June of 2013 and has been coming monthly since. My weight stayed the same and I’m still running quite a bit (trained for 2 marathons during this timeframe), but my diet naturally changed – much more fats and protein, less carbs. It wasn’t really intentional although I actively tried to add in more fats until it became second nature in my meal prep. I’m so glad that I got my period back naturally and I really wish that physicians would put more effort into their patient’s needs and not just prescribe birth control as a way to mask the problem.

I heard all of those same things from doctors years ago when I was experiencing ammenorrhea. I knew there was a connection in my lifestyle as well and honestly quit seeing medical professionals all together – it was ‘natural medicine’ (chiropractors, holistic health coaches, etc.) that aided me – along with my own daily choices that finally brought back my period. The medical field (and, of course, all of the people you’re going to help) is absolutely BLESSED to have you as a part of it.

I used to have super irregular periods, since I was like 16. I’d go 6-9 months without one. As an adult, I often skipped months, but didn’t go that far in between. Birth control didn’t help this at all. The weirdest thing is that when I started doing 60-miles a week with marathon training, my period has become more regular than EVER. I can predict it to the day. It’s insane and counter-intuitive. My theory is that because I run so much, I don’t avoid carbs. I eat a lot of carbs. I eat a reasonable amount of fats and proteins, but definitely heavy on the carb. I guess this pescetarian, carb-heavy, lots of exercise lifestyle works for my body.

Love this! A few years ago I had an unhealthy obsession with exercise and “nutrition” (eat real food! nothing processed! you’ll rot your body if you eat anything not organic!) and lost my period for about 9 months. The thing is, my BMI was technically over the ideal limit, and I was “overweight” for my height. My ob/gyn did ask me about my eating/exercise habits, but I downplayed it because I didn’t want to admit I had a problem. She recommended birth control, and I reluctantly went on it for about a year before I had enough. I eased up on myself and put on about 10-15 pounds. I got my periods back, and they’re about as regular as they were before (which is to say not quite like clockwork, but still every 21-28 days or so). I haven’t weighed myself in 6+ months, but I know that I’m a little overweight (sometimes it’s just a fact, not a body perspective issue). However, I’m so much happier than I was when I wouldn’t let myself enjoy a single bit of food without tracking it or planning it ahead of time down to the hour. When I see pictures of myself from a few years ago, slimmer, I get a little desire in me to wish to be that size, but then I remember how the night before a vacation with friends I was sitting on the floor crying because I wouldn’t be able to plan my meals ahead of time. That is not the life I want!

Also, I am extremely blessed to have a good friend who was a WHNP (is that a right title?) at the time and gently encouraged me to take a closer look at my habits. She’s now a DNP and pretty much the best friend a girl could have because she is so passionate about women’s health!

I LOVE your passion for this topic. It seems that there needs to be more curriculum on this in med school, especially for OB/GYNs and endocrinologists. I am so glad you are going on to be an NP and will be able to reach even more people and teach about the importance of having a period, and how diet and exercise play a critical role in menstruation, and health in general!

Yes absolutely love this! In Australia they don’t even acknowledge HA as a possibility when your period goes missing. Even after having an ED for years not one Dr has ever asked me to I eat enough and do I exercise to much, they just prescribe something to make it go away. Pretty sad really!

YES! I was put on birth control around 17 years old because I had heavy periods and very bad cramps. After 8 years on the pill, my cycles were so light and then one month it simply didnt come. I knew this wasn’t normal and was told by my DR it “wasn’t a big deal” either. Well, I knew I wanted a baby within the year when this happened, so I swiftly went off of those dang pills! Luckily, I had a normal cycle after this but I hate how its just perceived as normal and okay! I do not plan on ever going back on a pill as a form of birth control!

This is so great! I loved reading this. As someone that has struggled with Bulimia, compensating eating with exercise, this really hit home. I also began having very irregular periods while training for a half marathon last Spring. I didn’t know what the problem was and when I saw my doctor, she recommended birth control, saying that my estrogen levels were most likely too low. I suspected I was overexercising and mentioned this. She seemed to shrug it off, but did confirm that it could be a factor. I did take the birth control for a couple of months, but determined it wasn’t for me. The one thing I changed for myself was I began exercising less and taking care of myself more. My period has returned – like clockwork, and without the use of any medications!

Hi Robyn, I always read your blog but don’t generally comment. I wanted to know, as this post worried me. I’ll explain you my situation. I was taking birth control for 3 years, but stopped because I was getting a lot of hormonal problems (I was crying a lot, lost my sex drive, had huge mood swings, etc.). I recognised it was too much, out of my control, and so I stopped taking birth control and those problems went away. I have not had the period since then, 3 years ago. I went to the doctor and they did lots of tests, hormonal treatments (progesterone challenge but also another one that was like 6 months long) and even brain scans to see if my glands in the brain were ok, and everything was ok, my blood tests show healthy hormones and everything. They don’t know what can be happening. I’ve always exercised, maybe a bit too frequently before (5-6 days) but now it is more like 3 days of weight lifting a week, so not so much I think. I’ve always slept wonderfully, but I do clench my teeth (I don’t notice but my boyfriend sometimes does). A few years ago I didn’t eat much fat, but now I eat loads of nut butters, avocado, olive oil, coconut oil, etc… And I eat a lot, and very frequently because I’m hungry very frequently! Whilst taking birth control, but after all the problems were there, I went vegan (I don’t know if this is relevant, but I’m mentioning just in case). I was stressed last year and the year before, but this year is being super chilled… I also just checked what my BMI should be (I don’t really know how much I weight, but approx) and it’s 21. I really don’t know what to do anymore… 🙁 I mean, my tests are all good, and I don’t know if I can improve my lifestyle more… Do you have any suggestion? Hope you had a good weekend, and sorry for the long comment!

This is so interesting. So I’ve been wondering about my own period. I’ve always been irregular due to pcos. Usually too frequent. But currently I am nursing a baby quite frequently and going about 6 weeks between cycles. Any opinions on this situation?

Hi Robyn. Have you heard of post pill amenorrhea? I went off the pill in April 2015 and still haven’t got my period back! We want to start trying for a baby soon and I’ve been to a fertility specialist who diagnosed me with mild PCOS. As you can imagine, it’s very difficult trying as I can’t track any cycles. Any advice would be much appreciated.

There is some evidence, but it is limited, that women who have been on OCPs for many years may have a higher rate of irregular periods following stopping the pill – but that is really only in about 5% of women. Post pill amenorrhea is really not a thing- less than 1% of women could be affected by this. If anything, the pill could have been masking an underlying diagnosis – such as PCOS or HA all along.